Madeline Li1, Erin B Kennedy2, Nelson Byrne3, Caroline Gérin-Lajoie4, Mark R Katz5, Homa Keshavarz2, Scott Sellick6, Esther Green7. 1. Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada. 2. Cancer Care Ontario, Program in Evidence-based Care/McMaster University, Hamilton, Ontario, Canada. 3. Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga, Ontario, Canada. 4. Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada. 5. Stronach Regional Cancer Centre, Southlake Regional Health Centre, Ontario, Canada. 6. Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada. 7. Nursing and Psychosocial Oncology, Cancer Care Ontario, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Previous systematic reviews have found limited evidence for the effectiveness of pharmacological and psychological interventions for the management of depression in patients with cancer. This paper provides the first meta-analysis of newer collaborative care interventions, which may include both types of treatment, as well as integrated delivery and follow-up. Meta-analyses of pharmacological and psychological interventions are included as a comparison. METHODS: A search of MEDLINE, EMBASE, PsycINFO, and the Cochrane Library from July 2005 to January 2015 for randomized controlled trials of depression treatments for cancer patients diagnosed with a major depressive disorder, or who met a threshold on a validated depression rating scale was conducted. Meta-analyses were conducted using summary data. RESULTS: Key findings included eight reports of four collaborative care interventions, eight pharmacological, and nine psychological trials. A meta-analysis demonstrated that collaborative care interventions were significantly more effective than usual care (standardized mean difference = -0.49, p = 0.003), and depression reduction was maintained at 12 months. By comparison, short-term (up to 12 weeks), but not longer-term effectiveness was demonstrated for both pharmacological and psychological interventions. CONCLUSIONS: Collaborative care interventions have newly emerged as multidisciplinary care delivery models, which may result in more long-term depression remission. This review also updates previous findings of modest evidence for the effectiveness of both pharmacological and psychological interventions for threshold depression in cancer patients. Research designs focusing on combined treatments and delivery systems may best further the limited evidence-base for the management of depression in cancer.
BACKGROUND: Previous systematic reviews have found limited evidence for the effectiveness of pharmacological and psychological interventions for the management of depression in patients with cancer. This paper provides the first meta-analysis of newer collaborative care interventions, which may include both types of treatment, as well as integrated delivery and follow-up. Meta-analyses of pharmacological and psychological interventions are included as a comparison. METHODS: A search of MEDLINE, EMBASE, PsycINFO, and the Cochrane Library from July 2005 to January 2015 for randomized controlled trials of depression treatments for cancerpatients diagnosed with a major depressive disorder, or who met a threshold on a validated depression rating scale was conducted. Meta-analyses were conducted using summary data. RESULTS: Key findings included eight reports of four collaborative care interventions, eight pharmacological, and nine psychological trials. A meta-analysis demonstrated that collaborative care interventions were significantly more effective than usual care (standardized mean difference = -0.49, p = 0.003), and depression reduction was maintained at 12 months. By comparison, short-term (up to 12 weeks), but not longer-term effectiveness was demonstrated for both pharmacological and psychological interventions. CONCLUSIONS: Collaborative care interventions have newly emerged as multidisciplinary care delivery models, which may result in more long-term depression remission. This review also updates previous findings of modest evidence for the effectiveness of both pharmacological and psychological interventions for threshold depression in cancerpatients. Research designs focusing on combined treatments and delivery systems may best further the limited evidence-base for the management of depression in cancer.
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